Katelyn Crouch, Holli Schexnider, Victoria Sisco

October 5, 2016
Brown Oral Pathology

Case Study for Oral Pathology

Our patient is a 53 year old edentulous female who is visiting the office for an
evaluation of a large ulcerative area on the soft palate. She complains of pain in the affected
area and states that blisters had formed and then collapsed before the ulceration. The lesion
first appeared approximately two weeks earlier, and since then, the lesion has increased in size
and the pain has worsened. The patient mentioned no trauma to the area and no history of
similar lesions. She also denied the presence of any skin or eye lesions. The patient is taking
medication for hypertension and rheumatoid arthritis. She received complete dentures 12
years ago, and has had sporadic dental visits since then. No swollen or sore lymph nodes were
present and all vitals were within normal limits. During the intraoral exam, a large ulcerative
area was noted on the left side of the soft palate and on the adjacent pterygomandibular
raphe. No intact vesicles or bullae were noted in the region. There was also a similar small area
on the left buccal mucosa.
A citrical pemphigoid is a chronic autoimmune disease that affects the skin and oral
mucosa, conjunctiva, genital mucosa, and skin. We know that the lesion is probably not a
cicatricial pemphigoid because the patient has not had any skin or eye lesions. Also, the
patients lesion is present on the soft palate and on the pterygomandibular raphe; lesions
associated with cicatricial pemphigoid are most commonly found on the gingiva. The diagnosis
could be confirmed by biopsy or microscopic examination, but according to the patients
symptoms, cicatricial pemphigoid can likely be ruled out.
By definition, squamous cell carcinoma is a malignant tumor of squamous epithelium.

Katelyn Crouch, Holli Schexnider, Victoria Sisco

October 5, 2016
Brown Oral Pathology

Squamous cell carcinoma is the most common primary malignancy of the oral cavity and it can
grow into other tissues and spread. The patient did not have any swollen or tender lymph
nodes and since squamous cell carcinoma usually metastasizes in the lymph nodes this is an
indicator.
Pemphigus Vulgaris is a severe progressive autoimmune disease that affects both the
skin and mucous membranes. Vesicles and bullae are common with pemphigus vulgaris, the
bullae are so fragile they rupture soon after they form. The patient does not presently have
intact vesicles or bullae, but she did have blisters that formed and collapsed before the
ulceration began. Lesions of pemphigus vulgaris present as painful ulcers proceeded by bullae.
Bullae rapidly rupture, leaving red, painful, ulcerated base. The patient stated that the involved
area had increased in size and the pain had worsened. Most cases are noted within the fourth
and fifth decades of life and our patient is 53 years old. The diagnosis is made by biopsy and
microscopic examination but just using our context clues, we believe our patient has
pemphigus vulgaris.
Erythema multiforme is an acute, self-limited disease that affects the skin and mucous
membranes. Orally, lesions usually present as ulcers and are usually located on the lateral
borders of the tongue. There is no mention of any lesions occurring on the soft palate, and
frequently crusty and bleeding lips are associated with erythema multiforme, which our patient
does not have. Gingival involvement is rare. The cause of erythema multiforme is not clear, but
it may be triggered by the HSV infection, tuberculosis, and histoplasmosis, as well as drugs such

Katelyn Crouch, Holli Schexnider, Victoria Sisco

October 5, 2016
Brown Oral Pathology

as barbiturates and sulfonamides. Our patient is taking medication for hypertension and
rheumatoid arthritis.
Erosive lichen planus can be diagnosed when the epithelium separates from the
connective tissue, which results in erosions, bullae, or ulcers. This most commonly occurs on
the buccal mucosa, but may also appear on other mucosal tissues and the lips. Usually, lesions
also appear on the skin and may be itchy. The lesions may be premalignant, and lichen planus is
a chronic disease. Patients with lichen planus may be at an increased risk for squamous cell
carcinoma. The lesion that our patient is experiencing could be lichen planus; but we do not
think that is the best possible diagnosis because of the lesion location, and the fact that there
are no bullae noted. Also, no striations were mentioned on the buccal mucosa, which are a
common finding with lichen planus, however, the patient did have a small ulceration on her left
buccal mucosa.
After reviewing all of the possible diagnoses, we think our patient has pemphigus
vulgaris. The reason we have decided on this diagnosis is because pemphigus vulagris is often
noted within the fourth and fifth decades of life and our patient is 53 years old. Although she
did not have any intact vesicles or bullae, she did have blisters that formed and collapsed. This
diagnosis cannot be confirmed without surgical excision, but her clinical signs match this
diagnosis best.

Katelyn Crouch, Holli Schexnider, Victoria Sisco

October 5, 2016
Brown Oral Pathology

References
Regezi, JA & Sciubba, JJ, Oral Pathology: Clinical Pathologic Correlations, Sixth Edition, WB
Saunders Co., 2011.Oral Pathology for the Dental Hygienist. 6th edition. Olga A.C. Ibsen

and Joan Anderson Phelan

http://bmcoralhealth.biomedcentral.com/articles/10.1186/1472-6831-14-103 September 4,
2016
Oral Pathology for the Dental Hygienist, Olga Ibsen, RDH, MS, and Joan Phelan, DDS, W.B
Saunders Co., Philadelphia, PA, 2009.